Health Information Management: Integrating Information Technology ...

170 STRATEGY, IMPLEMENTATION AND EVALUATION
following chapter, in other words, we are more concerned with understanding,
acting upon and structuring the implementation process than with the futile attempt
to isolate individual contributors to either ‘success’ or ‘failure’.
THREE MYTHS ABOUT IS IMPLEMENTATION
Myth 1:
PCIS implementation is the technical realization ofa
planned system in an organization
Overlooking the fact that PCIS implementation will fundamentally affect the
health care organization’s structures and processes is one core reason for
implementation failure. All too often, still, we hear project leaders or IS
professionals speaking about ‘rolling out’ a system, or planning its ‘diffusion’.
Such terminology underestimates that whether it is anticipated as such or not, the
implementation of an information system in an organization involves the mutual
transformation of the organization by the technology, and of the system by the
organization. As emphasized in Chapter 2, this is a two-way process. On the one
hand, the technology will affect the distribution and content of work tasks,
change information flows, and affect the visibility of these work tasks and
information flows. Because of this, it will also change relationships between
(groups of) health care professionals and/or other staff. Electronic patient
records, for example, inevitably change one’s recording practices, and raise
questions about who will get access to whose data, under which conditions. This
may seem self-evident and innocuous, but such changes inevitably trigger subtle
(and sometimes not so subtle) social and political processes about who gets to
fill in what parts of the record, who ‘owns’ what information, and who gets to
check on whose work. In the case study of the implementation of a physician orderentry
system mentioned above, Massaro describes how physicians reacted
forcefully against the need to be more structured and precise in their writing of
their orders. The fact that Massaro chose to describe the physicians’ slow
adjustment to the system in terms of Kübler-Ross’s phases of mourning (denial,
anger, acceptance and so forth) is an indication of the depth at which these
change processes can affect existing organizational realities (Massaro 1993b).
Such organizational processes in their turn inevitably affect the system.
Pressures on the implementation staff may lead them to change authorization
procedures, for example, or to throw out elaborately coded entry-screens that (in
the eyes of the users) take up too much time.
CASE VIGNETTE
In a PCIS developed for a mental health care organization in the Netherlands,
we found that discussions about access rights to patient information had resulted
in an unwieldy explosion of over 25 different authorization levels. In this case,